{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:57:19Z","timestamp":1785585439280,"version":"3.56.0"},"reference-count":48,"publisher":"The Endocrine Society","issue":"11","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD100406"],"award-info":[{"award-number":["R01HD100406"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD58886"],"award-info":[{"award-number":["R01HD58886"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR001878"],"award-info":[{"award-number":["UL1TR001878"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR000077"],"award-info":[{"award-number":["UL1TR000077"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["N01-HD-1-3228, \u22123329, \u22123330, \u22123331, \u22123332, \u22123333"],"award-info":[{"award-number":["N01-HD-1-3228, \u22123329, \u22123330, \u22123331, \u22123332, \u22123333"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Race-specific reference ranges for pediatric areal bone mineral density (BMD) are widely used, but the value of race-based clinical algorithms has been questioned. We developed race-neutral pediatric reference ranges for areal BMD and bone mineral apparent density (BMAD) and compared race-specific vs race-neutral Z-scores in their ability to predict prospective fractures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Material and Methods<\/jats:title>\n                  <jats:p>This secondary analysis of the Bone Mineral Density in Childhood Study used longitudinal BMD data of the spine, hip, forearm, and total body less head and BMAD from dual-energy x-ray absorptiometry (DXA) scans. Race\/ethnicity, dietary calcium, physical activity, and prospective fractures were assessed by questionnaire. Race-neutral reference ranges and height-for-age Z-score adjustment equations were created using the lambda-sigma-mu method. Race-neutral and race-specific Z-scores were compared using linear mixed-effect modeling. Cox proportional hazard modeling was used to test whether race-neutral Z-scores associated with fracture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Race-neutral BMD and BMAD Z-scores were 0.5 to 0.7 SD greater than race-specific Z-scores for Black children but only \u223c0.1 SD lower for children from other race\/ethnicity groups. Growth and lifestyle factors modified group differences. One SD increase in race-neutral Z-scores was associated with a 12% to 18% reduced risk of fracture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We present the first race-neutral pediatric reference ranges for BMD and BMAD that are weighted to be representative of the US population and demonstrate that these Z-scores associate with fracture risk. Adoption of these new reference ranges should be considered, with thoughtful implementation for patients previously monitored with race-specific reference ranges, especially among children who identify as Black.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf183","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T06:59:55Z","timestamp":1742713195000},"page":"3034-3048","source":"Crossref","is-referenced-by-count":9,"title":["Race-neutral Pediatric Reference Ranges for Bone Mineral Density Predict Prospective Fractures in Childhood"],"prefix":"10.1210","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6164-7348","authenticated-orcid":false,"given":"Babette S","family":"Zemel","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Pediatrics, University of 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1143-4459","authenticated-orcid":false,"given":"Shana E","family":"McCormack","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"McWilliams","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan M","family":"Lappe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Creighton University , Omaha, NE 68124 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E","family":"Oberfield","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Cancer Center, University of Hawaii , Honolulu, HI 96813 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Struan F A","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Center for Spatial and Functional Genomics, Division of Human Genetics, The Children's Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Genetics, University of Pennsylvania 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